About the Author

Mark Lynas is editor of the international human rights and development website www.oneworld.net. He also coordinates...

"The problem with taking a blood sample for your malaria test is that the cockroaches may eat it in the night," announced the nurse. "Ants are an even worse problem. The place is infested with them." Siavonga Hospital, on the shores of Lake Karibe in southern Zambia, is suffering. "We have to put patients with TB in the same room as women who are giving birth," says one of the four Cuban doctors who battle to run the place. They also have to charge fees for their healthcare, and patients have to provide their own medicines, syringes and clean needles. What if they can't afford to pay? The doctor shrugs. "What do you think? They die."

People are dying. Quietly, but in huge numbers, all over Zambia, lives are being wasted. Wasted not because of some accident of nature but as a direct result of economic policies imposed by faceless Western planners. For more than twenty years now the World Bank and the International Monetary Fund have been forcing "structural adjustment programs," or SAPs, on the bankrupt countries of Africa. Trapped between a near-religious belief in economic neoliberalism and the US-driven interests of big business, these two institutions are blind to the havoc they are causing. Almost every country on the continent has succumbed to their prescription. Across Africa, the vultures are circling.

The World Bank has claimed that Zambia's reformed healthcare system is a model for the rest of Africa. "It's true that there are no queues," says Dickson Jere, a freelance journalist formerly with the Zambia Post, an independent daily. "But that's because people are simply dying at home."

They're called BIDs--"brought in dead." At the casualty ward in Lusaka's University Teaching Hospital (UTH), they are increasingly common phenomena, especially among children. "If you want to see the impact of structural adjustment on Zambia," Emily Sikazwe, director of the antipoverty group Women for Change, told me, "Go to UTH."

I went to UTH. It is Lusaka's biggest hospital, where those who can't afford private healthcare end up. In a packed ward near the main entrance a man writhed in bed. "I'm dying," he moaned, while his wife stood helplessly by his side. Emaciated figures shivered under sparse bedclothes. Families crowded around beds or sat on the floor, bringing food to the sick to supplement the meager hospital rations of beans and maize meal. In another ward a preacher harangued a dying woman, whose family stood around with heads bowed. As he waved his Bible, she struggled to move her lips to acknowledge him.

Enter the children's ward and the smell hits you like a wall. A musty, medicinal odor--the smell of sickness and death. Rows of children lie on small beds, slowly passing away from preventable diseases like TB, malaria and pneumonia. On the other side of the building is a cleaner, neater ward, where half the beds stand empty. This is the fee-paying section, where families who can pay a 100,000-kwacha ($36) deposit can buy a slightly better chance of life. In World Bank language, this is "user-responsive healthcare."

Don't just go to UTH. Go also to Misisi or to any of the twenty or so shanty "compounds" that ring Lusaka. In Misisi, barely a kilometer from Lusaka's town center, Masauso Phiri stands outside the windowless concrete shed that is his house. Next door an old man nearly died of starvation--luckily, he was saved by the return of his son from the Copper Belt, where he worked in the mines. That's not unusual. People are dying of starvation in Misisi. But they do so quietly, wasting away in their houses, too ashamed to venture out. Things were not always like this.